Table 2.

Attitudes of Patients Toward their Inhalers: Quotations from the Semi-Structured Interviews

Core themes from semi-structured interviews	Patient ID and device type	Quotations
Asthma inhalers and expectations	P13, uses pMDI	“I am getting results and for me the result is this, my asthma declines, my breathing is easier and also if I have some sort of congestion, it releases the congestion and actually clears my lungs… because it works, my technique must be good.”
	P7, uses pMDI	“My greatest concern is that I have to use it for the rest of my life.”
	P22, uses pMDI and Turbuhaler®	“I would not be without it; I am very dependent on it. I would not go anywhere. If I go anywhere and I do not have it, I will be a bit nervous.”
	P23, uses an Accuhaler®, Turbuhaler, and pMDI	“I have been trying different things and then I end up using this one. Before, I had xxxx (a type of Turbuhaler). It was not good either. They all have something… I get anxiety reactions.”
	P25, uses Turbuhaler	“I have used it all my life so am very comfortable with it. I know how to use it.”
	P24, uses pMDI	“You can feel the benefit of it which is important. So I really don't want to change it, you know. If I am getting comfort and relief from that, I think that is the main thing.”
Inhaler preference	P20, uses Turbuhaler	“Sometimes tough if you are suffering from asthma, you can't take a deep breath to inhale really deeply. With a good inhaler you have got to take a normal breath and it just goes in.”
	P17, uses pMDI	“I quite like the way that some of them now have the little numbers on it, so I know when it runs out instead of keep trying, when you realise that there is actually nothing left into it.”
	P3, uses Accuhaler and pMDI	“I don't like xxxx (a type of pMDI) not being able to completely tell them when it runs out.…dose counter would be better.”
	P25, uses Turbuhaler	“It is easy to carry around. I travel quite a bit for work so it is not a big thing to carry around.”
	P17, uses pMDI	“What I dislike is when I throw them in my bag and something gets caught in them and I go to use it and it goes to my lung…Things can go down inside it or if I lost the cap on the end, lots of funny things end up from my handbag in there then end up down in my lungs.”
	P13, uses an Accuhaler	“What do I like most about it is just the fact that it has got the mouthpiece covered up.…the hygiene fact to it. That would be the positive thing.”
	P22, uses Turbuhaler	“I never know whether I loaded it or not and I can be doing this and I don't know whether I am wasting it and it is expensive, very expensive.”
Characteristics of an ideal inhaler	P13, uses Accuhaler and pMDI	“Easy to use…compliance because you have something you have to take it, particularly the steroid ones… If it is too hard, you do not take it and also just trying to remember to take it, linking that to something you do like brushing your teeth.”
	P24, uses pMDIs	“Gauge on the xxxx (a type of pMDI) would be a big advantage… I wouldn't like to be caught up without having something in the inhaler.”
	P1, uses pMDIs	“It would be lighter and smaller, the portability reasons.”
	P12, uses pMDI	“Keep it clean so nothing would get on top of it.”
	P25, uses Turbuhaler	“If there was a way of monitoring the delivery of medication that wouldn't be a bad feature to have as well, just in terms of making ensuring.… For the people who have to monitor their asthma very carefully, method of monitoring the delivery of the medication would be useful to have as well.”
Perceived effectiveness of inhalers	P13, uses an Accuhaler and pMDI	“I am getting results and for me the result is the asthma declines, my breathing is easier and also if I have got some sort of congestion, it releases the congestion and actually enables me to clear the lungs… because it works my technique must be good.”
	P25, uses Turbuhaler	“Whether I am getting the full dose I am not sure but certainly in terms of its effects, it seems to work well and I do not have an asthma attack for a long time so I have got no reason to doubt that I am not doing it correctly.”
	P20, uses pMDIs	“Confident. I have been using them all my life so it's like blinking.”
	P12, uses pMDI	“It is something I have used probably for about 10 years so yes very confident. My technique is effective.”
	P23, uses an Accuhaler, Turbuhaler, and pMDI	“I use it in the right way. The way the doctor showed me.”
	P20, uses pMDI	“It is pretty much; I mean it's not like a science. Is it? Yeah open your mouth and put your head back and take a couple of puffs and pretty much, if I can do it, anyone can do it.”
	P11, uses Turbuhaler and pMDI	“I usually get the taste. I can taste the medication … Yeah it has a certain taste.”
	P9, uses Accuhaler and pMDI	“I am not sure if I am using them in the right way but yeah it is working.”
	P7, uses pMDIs	“I don't mind using the inhalers. I can manage it pretty well. I prefer using the spacer because I don't think I'll be comfortable just using the inhaler by itself with my technique, so that's why I use it with the spacer.”
Inhalers and patient decision making	P21, uses an Accuhaler and pMDI	“No, I have always got the one doctor says, the doctor says take that I will take that. I don't take away from that because I trust them after years.”
	P18, uses pMDI	“I was just thinking, I would take the advice of my doctor because he has an educated opinion.”
	P25, uses Turbuhaler	“The sort of the device I use is not that important to me, it is the effect it has on me and the management of my condition is more important than how it is administered.”
	P13, uses an Accuhaler and pMDI	“It is not about the method of delivery for me. It's about delivery. It's about what medication does.”
	P8, uses Turbuhaler	“xxxx (a type of pMDI), I just wasn't getting any benefit from it because I couldn't take it, I couldn't breathe at the right time and I found it really uncomfortable to use and they told me xxxx (a type of Turbuhaler) they give to children so I told them Ok I'll try that one and because it is very mild and it's just exercise induced asthma then I don't need anything stronger.”

pMDI, Pressurized metered dose inhaler.